Bucciarelli R L, Nelson R M, Egan E A, Eitzman D V, Gessner I H
Pediatrics. 1977 Mar;59(3):330-7.
Fourteen term newborn infants have been recognized as having transient tricuspid insufficiency associated with significant perinatal stress. Five of these infants underwent cardiac catheterization for presumed congenital heart disease, but had only massive tricuspid valve insufficiency. The other nine infants were diagnosed on the basis of a murmur characteristic of tricuspid valve insufficiency and on other clinical grounds. All had a history of significant perinatal stress in the form of asphyxia with or without hypoglycemia. Frequently, congestive heart failure, persistent cyanosis, and ECG evidence of myocardial ischemia were present. Twelve of the 14 survived, and in each of them all cardiac signs and symptoms, including the murmur, spontaneously resolved. The two patients who died had histopathologic evidence of necrosis in the anterior papillary muscle of the tricuspid valve. The constant features of perinatal stress, ST-T wave abnormalities on the ECG, and spontaneous resolution of the transient tricuspid insufficiency strongly suggest that this syndrome is secondary to a reversible form of myocardial dysfunction, perhaps by affecting papillary muscle specifically. We believe that hypoxia with or without hypoglycemia precipitates the events leading to this clinical syndrome which is distinguishable from other cardiac abnormalities in the newborn by the history, distinctive murmur, and the ECG abnormalities.
14名足月儿被认定患有与严重围产期应激相关的短暂性三尖瓣关闭不全。其中5名婴儿因疑似先天性心脏病接受了心导管检查，但仅发现严重的三尖瓣关闭不全。另外9名婴儿是根据三尖瓣关闭不全的特征性杂音及其他临床依据确诊的。所有婴儿都有以窒息伴或不伴低血糖形式存在的严重围产期应激史。常出现充血性心力衰竭、持续性发绀及心肌缺血的心电图证据。14名婴儿中有12名存活，他们每个人的所有心脏体征和症状，包括杂音，都自行消失了。死亡的两名患者在三尖瓣前乳头肌有坏死的组织病理学证据。围产期应激的持续特征、心电图上的ST-T波异常以及短暂性三尖瓣关闭不全的自行缓解强烈提示，该综合征继发于一种可逆性心肌功能障碍形式，可能是特异性地影响了乳头肌。我们认为，伴或不伴低血糖的缺氧引发了导致这种临床综合征的一系列事件，该综合征通过病史、独特的杂音和心电图异常与新生儿其他心脏异常相区别。
